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Medical Aid Frequently Asked Questions
Browse our Frequently Asked Questions section to find out more about medical aids and how to gain maximum benefit out of your personal or family medical aid plan.
How do I decide which medical aid scheme to join?
Choosing the right South African medical aid scheme and plan is crucial. For starters, you should be sure that the scheme you're considering is legally registered and financially stable.
You can verify your medical aid scheme's accreditation on the website of the Council for Medical Schemes.
Consulting your local doctor or closest hospital accountant will also give you an indication of their payment record and how swiftly they process medical claims.
Avoid medical aid schemes that take months to process claims, as you may be expected to foot the bills in the interim. Be sure to read all documentation carefully, making notes of exclusions, rules as well as the conditions pertaining to benefits and hospital cover.
Also find out which chronic medical conditions are covered by the scheme and whether you'll have to make any monthly contributions.
If you feel somewhat overwhelmed by all the medical aid options, it may be a good idea to consult an independent medical aid broker. (S)he will be able to give you a good idea of what you should be looking for, as well as the potential pitfalls.
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How do I select the best medical aid option?
Assess your medical needs by consulting a medical aid broker, or contact a number of respected South African medical schemes independently. Choose a plan that suits your needs; if you're healthy and not prone to sickness, it may be a good idea to get a medical aid plan that features low day-to-day benefits, but substantial hospital coverage.
This will stand you in good stead in the case of a car accident, for example. Always read the small print regarding benefits, thresholds and conditions for cover. |
Can anyone become a member of a medical scheme?
Yes, providing they can pay the required monthly premiums. In some instances, treatment for a particular condition or medical need may be excluded for a period of time. For example, you cannot sign up for a comprehensive medical aid plan with maternity cover after you've already fallen pregnant.
The best time to obtain good medical cover is now, while you are still healthy and not afflicted. Additionally, some medical schemes may charge higher rates for people who only join once they start getting older. |
What are open and closed medical schemes?
Membership of open medical schemes is open to all members of the public. Membership of closed medical schemes is restricted to employees, a specific profession, association or union. |
What are day-to-day medical aid limits?
Day-to-day cover limits determine the maximum that a medical aid member or his/her dependants can spend on minor medical expenses (predominantly out-of-hospital expenses) during the course of a given year. These medical cover limits usually apply to specific categories (dental, consultations, specialist appointments, physiotherapy, etc.)
The lower the cost of your medical aid plan, the lower the day-to-day medical cover limits will be. However, most hospital plans, despite the lower costs associated with these, will still feature sufficient hospital cover. On some medical aid plans the day-to-day limits are quite high, but this will obviously be reflected in higher monthly membership premiums. |
Can one person belong to more than one medical scheme?
No person may belong to more than one medical scheme. Intentionally trying to sign up for medical aid with more than one medical aid scheme could be considered fraudulent. |
Can a medical scheme terminate my membership?
Yes. An open medical scheme can terminate your membership if you don't pay your monthly contributions. A closed scheme can exclude you if you leave the company, or if you get retrenched. |
Am I covered for medical treatment if I've resigned?
You are still covered for treatment until the last day of your notice period. After that, you are responsible for paying your own monthly contribution in order to keep your cover intact.
Contact a Selfmed medical aid consultant if you have any other unanswered questions on this topic. |
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